Medical Archives | Mennonite Collegiate Institute

Name *

First

Last

Email *

Phone *

Gender *

Male
Female

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you currently an MCI Student? *

Yes
No

Are you currently an MCI dorm student? *

Yes
No

Are you a Youth or a Leader? *

Youth
Leader

Select the dates you would like to attend the event *

Friday April 14, 2023 and Saturday April 15, 2023 (No overnight)
Saturday April 15, 2023: Only, All-day

Please select your T-Shirt Size *

Health Information

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Name on Card *

PHIN (9 digit) *

Family # (6 digit) *

Allergies/Medical concerns (list all)

Addition comments

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Church/Organization affiliation (if any)

Roommate request

Are you booking as a group? If yes, please identify the leader of the group:

Parent/Guardian

Name *

First

Last

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Relationship *

Phone *

I am attending Youth Orbit with the consent of my parent/guardian. *

I am attending Youth Orbit with the consent of my parent/guardian. I authorize the staff of Mennonite Collegiate Institute to act for me/my child according to their best judgment in any emergency requiring medical attention, and I waive and release MCI of any and all liability for any injuries or illnesses incurred while at Youth Orbit

Refund Policy *

I understand that until March 25th, I may request a refund on individual registrations. (MCI will charge you a $30.00 administration fee.) If extenuating circumstances arise after March 25th, please contact our office. These requests will be handled on a case by case basis.

Photograph Policy *

I grant MCI permission to use any photographs and/or video images of me/my child taken at the event for advertising purposes authorized by MCI.

Electronic Communicatoin Policy *

I agree to receive electronic communications from MCI for the purposes of promotion, or school information that may be of interest. I understand that I can unsubscribe at any time and that my information will not be shared at any time.

Student Price

Price: $50.00

Leader Price

Price: $50.00

Saturday Only Price

Price: $65.00

No Overnight Stay Price

Price: $75.00

Credit Card *

Card

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Medical Breakthrough

Youth Orbit 2023 – Online Registration

Health Information

Parent/Guardian

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